Healthcare Provider Details

I. General information

NPI: 1376693630
Provider Name (Legal Business Name): TARA ELIZABETH SAUNDERS CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E KILBUCK ST
TECUMSEH MI
49286
US

IV. Provider business mailing address

PO BOX 548
ADRIAN MI
49221
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-3887
  • Fax:
Mailing address:
  • Phone: 517-265-0229
  • Fax: 517-265-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801080138
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: